Outcomes of home-based versus facility-based care for mild diphtheria during a large epidemic in Kano State, Nigeria: A retrospective matched cohort study
by Jonathan Polonsky, Suleiman Hudu, Khadidja Uthman, Yves Katuala, Philip Eghosa Evbuomwan, Hashim Juma Omer Osman, Abdulwahab Kabir Sulaiman, Ichola Ismael Adjaho, Cheick Oumar Doumbia, Etienne Gignoux, Franck Ale Background During Nigeria’s largest recorded diphtheria epidemic (first notified on 1 December 2022; more than 40,000 confirmed cases by January 2026), hospital capacity in Kano State…
During Nigeria's largest recorded diphtheria epidemic, Médecins Sans Frontières (MSF) implemented home-based care (HBC) for patients with mild disease in Kano State, Nigeria. A retrospective matched cohort study compared mortality, long-term sequelae, and household transmission between HBC and care in a diphtheria treatment centre (DTC).
The study analyzed 669 patients, 362 treated at home and 307 in a DTC, adjusting for factors like age, vaccination status, and treatment delay. Results showed that mortality was lower with HBC than DTC care, but treatment delay increased mortality risks. Vaccination was linked to lower odds of death. HBC did not increase household transmission or long-term sequelae.
The study suggests decentralised care as an option for managing mild cases during diphtheria epidemics in areas with limited hospital capacity, but cautions for residual confounding factors and a small number of deaths.
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